Background: We hypothesized that preoperative cryoneurolysis of the superficial genicular nerves in patients with osteoarthritis would decrease postoperative opioid use relative to standard of care (SOC) treatment in patients undergoing total knee arthroplasty (TKA). Methods: Patients received either cryoneurolysis (intent-to-treat [ITT]: n ¼ 62) or SOC (ITT: n ¼ 62). The cryoneurolysis group received cryoneurolysis of the superficial genicular nerves 3e7 days before surgery plus a similar preoperative, intraoperative, and postoperative pain management protocol as the SOC group. The primary end point was cumulative opioid consumption in total daily morphine equivalents from discharge to the 6-week study follow-up assessment. Secondary end points included changes in pain and functional scores. Primary and secondary end points were assessed using ITT and per-protocol (PP) analyses. Results: The primary end point was not met in the ITT analysis (4.8 [cryoneurolysis] vs 6.1 [SOC] mg; P ¼ .0841) but was met in the PP analysis (4.2 vs 5.9 mg; P ¼ .0186) after excluding patients with medication deviations or missing follow-up data. Compared with the SOC group, the cryoneurolysis group had improved functional scores and numerical improvements in pain scores across all follow-up assessments, with significant improvements observed in current pain from baseline to the 72-hour and 2-week follow-up assessments and pain in the past week from baseline to the 12-week follow-up assessment. Conclusion: Findings from the PP analysis suggest that preoperative cryoneurolysis in patients with knee osteoarthritis can reduce opioid consumption and improve functional outcomes after TKA.

The anterior centre-edge (VCA) angle quantifies the anterior cover of the femoral head, and angles of less than 20 degrees are considered abnormal. We have measured the VCA angles in hips without osteoarthritic changes. We took bilateral false-profile radiographs of nine female and 30 male cadavers without signs of osteoarthritis. The mean age at the time of death was 72 years (46 to 92). The mean VCA angle was 32.8 degrees (17.7 to 53.6). The SD was 7.9 degrees. Our findings suggest that the threshold of abnormality of the VCA angle may be slightly lower than previously thought. This information may be useful in counselling patients with asymptomatic acetabular dysplasia.

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